Study On The Role Of MLR In Predicting Acute Kidney Injury After Cardiac Valve Surgery

Purpose:Valvular heart disease(VHD)is a disease in which the function of the valve leaflets is progressively reduced under the influence of multiple factors such as heredity or environment.The human heart valve is an anisotropic organ with a complex microstructure that maintains the unidirectional flow of blood and dynamically responds to heart remodeling.These pathologies usually manifest as stenosis,regurgitation or pathological leaflet thickening.Valvular heart disease(VHD)is still one of the most important types of cardiovascular diseases in cardiac surgery.Heart valve replacement surgery plays an important role in reducing patient mortality and improving the quality of life of patients.Valve replacement surgery is also following the paracoronary artery.The second largest type of cardiac surgery after road transplantation.However,cardiac surgery has a high risk and many postoperative complications.Among them,acute kidney injury(AKI)is a common complication after cardiac surgery.AKI is becoming more and more common,and it is related to the gradual loss of renal function and cardiovascular Illness is related to death.The incidence of AKI is between 4%and 42%,which is associated with a 3-8 times higher perioperative mortality rate.Although most cases of AKI can be reversed by renal replacement therapy(RRT)in a short period of time,a large number of epidemiological and clinical studies have confirmed that there is a strong relationship between AKI and chronic kidney disease(CKD)and end-stage renal disease(ESRD).Associated,even minor renal impairment can affect the short-term and long-term prognosis after cardiac surgery.How to effectively reduce the possibility of renal function damage in patients after surgery and predict the risk of renal function damage has become one of the key research areas of cardiac surgery.Preoperative systemic inflammatory markers can be easily measured by routine blood samples,are inexpensive,and their value in predicting renal insufficiency has been described.The main markers of systemic inflammation include the ratio of monocytes to lymphocytes(MLR),the ratio of neutrophils to lymphocytes(NLR),and the ratio of platelets to lymphocytes(PLR).However,little is known about the predictive value of these markers in the risk of AKI after cardiopulmonary bypass.Therefore,the current study aims to verify whether these markers can predict the occurrence of AKI after heart valve replacement surgery.Methods:In this retrospective analysis,we collected 331 patients from Qilu Hospital of Shandong University who underwent heart valve surgery between December 2017 and December 2018,and divided the patients into the study group with AKI according to the KDIGO diagnostic criteria(37 persons)and a control group(294 persons)without renal impairment,and the patients were all adults over 18 years old.Continuous numerical variables are represented by mean±standard deviation;population data between groups are represented by frequency,percentage or mean±standard deviation;single variable analysis between groups is corrected by Pearson chi-square test;continuous numerical variables are represented by independent sample t test;Multiple logistic regression analysis is used to screen high-risk independent variables related to postoperative acute renal failure,ROC curve analysis of AUC value of new inflammatory response markers and calculation of sensitivity and specificity.Using Windows SPSS 20.0(SPSS Incorporated,Chicago,IL,USA)for statistical analysis of data,P<0.05 was considered statistically significant.To study whether MLR can predict the occurrence of AKI after VHD.Results:37 patients(11.2%)were found to have postoperative AKI.The MLR of patients with AKI was significantly higher than that of patients without AKI(0.41±0.16 vs 0.28±0.11,P<0.05).The ROC curve showed that the area under the curve(AUC)used to predict the MLR of AKI was 0.772(P<0.05),and the cutoff value was 0.47(sensitivity:89.2%;specificity:58.2%).Multivariate logistic regression analysis showed that higher MLR(≥0.47)was an independent predictor of AKI(OR:2.951,95%CI:1.412-6.167,P<0.005).Conclusion:These results show that under the KDIGO standard,patients with AKI after heart valve replacement have a good correlation with MLR,and can be used as a cost-effective predictor of AKI for patients after heart valve replacement surgery.